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April 15, 2021Circulation JournalOpen Access

Prevalence and Prognostic Significance of Pulmonary Function Test Abnormalities in Hospitalized Patients With Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction

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Why the study?

Does an abnormal pulmonary function test predict cardiovascular mortality or heart failure hospitalization in patients with acute decompensated heart failure?

Population

657 hospitalized patients with acute decompensated heart failure, mean age 73.3, 59.4% male, from a…

Comparison

Abnormal pulmonary function test on spirometry… vs Normal pulmonary function test on spirometry…

Design

Cohort

Follow-up

median 960 days (IQR 518-1,647 days)

Key result

Abnormal pulmonary function tests were present in 63.0% of patients with acute decompensated heart failure and independently predicted an increased risk of cardiovascular mortality or heart failure hospitalization (adjusted HR 1.402).

Authors

RKRika KawakamiYNYasuki NakadaYHYukihiro Hashimoto

Discussion

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Member takes

Overview

Abnormal PFTs should not yet alter ADHF management; leaves open their incremental value for risk stratification.

Study Design

Type

Cohort (n=657)

Multicenter

No

Structured PICO

Does an abnormal pulmonary function test predict cardiovascular mortality or heart failure hospitalization in patients with acute decompensated heart failure?

P
Population
657 hospitalized adults with acute decompensated heart failure who underwent spirometry before discharge, followed for a median of 960 days.
E
Exposure
Abnormal pulmonary function test (PFT) on spirometry before discharge (restrictive, obstructive, or mixed pattern)
C
Comparator
Normal pulmonary function test (PFT) on spirometry before discharge
O
Outcome
Composite of cardiovascular mortality or hospitalization for heart failurecomposite

Main Result

Hazard Ratio: 1.402 (95% CI 1.039–1.914)

p-value: p=0.027

Abnormal pulmonary function tests, particularly restrictive and mixed patterns, are highly prevalent in acute decompensated heart failure and independently predict worse clinical outcomes in patients with HFpEF.

Limitations

  • Single centre with a relatively small registry-based patient cohort
  • Diagnosis of restriction was based on FVC and not on total lung capacity, potentially overestimating the number of patients with reduced lung volumes
  • Spirometry was performed without a bronchodilator, which may underestimate the FEV1/FVC ratio and overdiagnose COPD
  • Comorbidities in elderly patients, including cognitive impairment and apraxia, may influence the quality of spirometry
  • Optimal timing of PFT to identify the prevalence and pattern of lung function abnormalities has not been clarified
  • Single-centre registry
  • Exclusion of 290 patients who lacked PFT results (potential selection bias)

Cite This Study

Kawakami et al. (2021) conducted a cohort in Acute decompensated heart failure (n=657). Abnormal pulmonary function test vs. Normal pulmonary function test was evaluated on Composite of cardiovascular mortality or hospitalization for heart failure (HR 1.402, 95% CI 1.039-1.914, p=0.027). Abnormal pulmonary function tests were present in 63.0% of patients with acute decompensated heart failure and independently predicted an increased risk of cardiovascular mortality or heart failure hospitalization (adjusted HR 1.402).

synapsesocial.com/papers/6a20106190ba8bd81b65b86bhttps://doi.org/10.1253/circj.cj-20-1069
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